Relationship between mental health and unmet need for contraception and method type among women living with HIV in Kenya
- 1Kenyatta National Hospital
Abstract
Contraception is important for preventing unintended pregnancies and reducing maternal and infant mortality. Among women living with HIV (WLHIV), it is also central to preventing vertical HIV transmission. Yet unmet need for contraception remains high among WLHIV in sub-Saharan Africa. Mental health symptoms may contribute to unmet need, but evidence among WLHIV remains limited. We examined the relationship between depression and anxiety and unmet need for contraception.
We used baseline survey data from Kenyan WLHIV receiving routine HIV care participating in a cluster randomized clinical trial evaluating a reproductive health counselling intervention at 10 HIV clinics. Women who were fecund, did not desire a pregnancy within two years, and not using a modern method of contraception were considered to have unmet need for contraception and were eligible for this analysis. Surveys captured data on depression, anxiety, fertility intentions and contraceptive use. We constructed separate generalized linear models to assess the relationship between depression and/or anxiety and unmet need for contraception.
Among 2,334 women in the analysis, the median age was 34; 9% (n=221) reported symptoms of at least mild depression, 9% (n=200) anxiety, 13% (n=305) either condition, and 5% (n=116) both. Overall, 84% (n=1,952) used a modern contraceptive method, 16% (n=378) had an unmet need for contraception, and 41% (n=784) used LARC. In univariate analysis, unmet need for contraception was 43% higher among women with either at least mild depression or at least mild anxiety (Prevalence Ratio [PR]=1.43, 95% Confidence Interval [CI]: 1.22-1.67); results were similar in the adjusted model (adjusted PR [aPR]=1.30, 95% CI: 1.08-1.58). No relationships were detected between anxiety or depression alone and unmet need.
WLHIV with either depression or anxiety had higher unmet need which suggests that mental health conditions may pose barriers to contraceptive use and may need additional support to achieve their reproductive health goals. Additional attention to mental health needs during contraceptive counselling may support informed contraceptive decision-making.
Related
- Structural associations between health insurance and mental well-being among people living with HIV: a multi-method analysis
- Disability, discrimination and mental health concerns among young women living in urban poverty: empirical analyses of the TOPOWA study
- Mental health and socioeconomic determinants of suicide risk among people living with HIV in Taiwan: an 18-year national cohort study
- The relationship between implicit and explicit stigma of mental illness among mental health clinicians: a systematic review and meta-analysis
- Major differences in the relationship between electronic health literacy, social capital and negative mental health states among the university students in China
BibTeX
@misc{karume2026relationship,
title = {{Relationship between mental health and unmet need for contraception and method type among women living with HIV in Kenya}},
author = {A. K. Karume and A. Seth and N. Ngumbau and C. Atieno and J. Moraa and K. Beima-Sofie and B. A. Richardson and J. A. Unger and A. Bhat and J. Kinuthia and A. L. Drake},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.10.26362702},
url = {https://www.medrxiv.org/content/10.64898/2026.09.10.26362702v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Relationship between mental health and unmet need for contraception and method type among women living with HIV in Kenya
AU - A. K. Karume
AU - A. Seth
AU - N. Ngumbau
AU - C. Atieno
AU - J. Moraa
AU - K. Beima-Sofie
AU - B. A. Richardson
AU - J. A. Unger
AU - A. Bhat
AU - J. Kinuthia
AU - A. L. Drake
PY - 2026
DA - 2026/09/10
PB - medRxiv
DO - 10.64898/2026.09.10.26362702
UR - https://www.medrxiv.org/content/10.64898/2026.09.10.26362702v1
AB - Contraception is important for preventing unintended pregnancies and reducing maternal and infant mortality. Among women living with HIV (WLHIV), it is also central to preventing vertical HIV transmission. Yet unmet need for contraception remains high among WLHIV in sub-Saharan Africa. Mental health symptoms may contribute to unmet need, but evidence among WLHIV remains limited. We examined the relationship between depression and anxiety and unmet need for contraception. We used baseline survey data from Kenyan WLHIV receiving routine HIV care participating in a cluster randomized clinical trial evaluating a reproductive health counselling intervention at 10 HIV clinics. Women who were fecund, did not desire a pregnancy within two years, and not using a modern method of contraception were considered to have unmet need for contraception and were eligible for this analysis. Surveys captured data on depression, anxiety, fertility intentions and contraceptive use. We constructed separate generalized linear models to assess the relationship between depression and/or anxiety and unmet need for contraception. Among 2,334 women in the analysis, the median age was 34; 9% (n=221) reported symptoms of at least mild depression, 9% (n=200) anxiety, 13% (n=305) either condition, and 5% (n=116) both. Overall, 84% (n=1,952) used a modern contraceptive method, 16% (n=378) had an unmet need for contraception, and 41% (n=784) used LARC. In univariate analysis, unmet need for contraception was 43% higher among women with either at least mild depression or at least mild anxiety (Prevalence Ratio [PR]=1.43, 95% Confidence Interval [CI]: 1.22-1.67); results were similar in the adjusted model (adjusted PR [aPR]=1.30, 95% CI: 1.08-1.58). No relationships were detected between anxiety or depression alone and unmet need. WLHIV with either depression or anxiety had higher unmet need which suggests that mental health conditions may pose barriers to contraceptive use and may need additional support to achieve their reproductive health goals. Additional attention to mental health needs during contraceptive counselling may support informed contraceptive decision-making.
ER -